Pre-existing osteoporosis and serum vitamin D levels in patients with distal radius fractures: are we missing something?

• Published in: Archives of orthopaedic and trauma surgery Vol. 144; no. 3; pp. 1281 - 1287
• Main Authors: Falk, Steffi S. I., Richter, Meike, Schröder, Josephine, Böhme, Sina, Mittlmeier, Thomas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2024; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Bone Density; Clinical trials; DRKS; DRKS00028085; Humans; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoporosis; Osteoporosis - diagnosis; Osteoporotic Fractures - drug therapy; Radius Fractures - complications; Radius Fractures - therapy; Risk Factors; Trauma Surgery; Vitamin D; Vitamin D - therapeutic use; Wrist Fractures; Diagnosis gap; Distal radius; Osteoporosis; Treatment gap; Vitamin D; Elderly
• ISSN: 1434-3916; 0936-8051; 1434-3916
• DOI: 10.1007/s00402-024-05199-4

Introduction
Given the significant therapeutic gap for osteoporosis, this study aims to investigate the most common osteoporosis-related fracture. The analysis will also consider patients’ serum vitamin D levels and the indications for basic osteoporosis diagnostic tests and osteoporosis therapy prior to fracture.
Materials and methods
This prospective clinical trial included patients with distal radius fractures who underwent surgery at our hospital between 1 April 2021 and 7 April 2022. Blood samples were taken from all participants and existing risk factors for osteoporosis were recorded. In addition, the indication for a guideline-based osteoporosis diagnosis was assessed and the risk of another future fracture with FRAX
®
was calculated. This information was used to decide whether there was an indication for specific osteoporosis therapy.
Results
A diagnosis gap of 53% and a treatment gap of 84% were identified among the 102 patients investigated. The patients’ ages ranged from 46 to 91 years, with an average vitamin D level of 57 nmol/l, which was below the recommended level of 75 nmol/l. It was noted on a monthly basis that the vitamin D level (without substitution) never exceeded the recommended value of 75 nmol/l in any month. Three-quarters of patients had indications for a baseline osteoporosis diagnosis, yet less than 50% received one. According to FRAX
®
data, 57% of patients had indications for specific osteoporosis treatment before experiencing the fracture.
Conclusion
Even without a previous distal radius fracture, many patients are in need of osteoporosis diagnosis or treatment. Our research suggests that patients with distal radius fractures should have their vitamin D levels checked via a blood test and be evaluated for osteoporosis. As endogenous vitamin D levels are often inadequate, year-round vitamin D supplementation should be considered for the prevention of osteomalacia and as a basis for the treatment of osteoporosis.
German clinical trial register ID
DRKS00028085.